Michelle Hawks

MSPH, Associate Specialist, Research Analyst | Western Region of Kenya

“…The woman just cried and said that she wanted to get an IUD…”

Over 50 women were sitting in line waiting to be seen by the doctors. And yet it was not that there were so many of them that caught my attention, but rather that all of them, without a single exception, were holding an infant. These women had left their homes bright and early to attend the Marie Stopes mobile Family Planning (FP) clinic. The clinic was a community center that had been converted by a traveling team of doctors into a FP clinic for the day.

Most of the women were in line to get an Implant inserted. When I asked why they had chosen an implant as their FP method they mentioned that they wanted a long term method. An IUD was not considered because they believed that the IUDs would travel through your body.

We then walked over to where doctors were performing tubal ligations. They had performed three female sterilizations so far and two more women were waiting for the procedure. One of the women waiting was crying. We were told that the woman who was crying had come in with her 3 week old baby and her husband, who announced that unless she got a tubal ligation she could not return home and left. The woman just cried and said that she wanted to get an IUD and not sterilized because she was scared of the tubal ligation procedure. When the counselors went to her they learned that she was holding her 11th child and that she was only in her mid-thirties, making her a poor candidate for an IUD. Since she had tried the implant before and did not like it they recommended that she go through with the sterilization.

Since her concerns with sterilization were based on fear, I suggested that they have a woman who had just been sterilized that morning share her experience. It was when she spoke to her that we learned the real reason for why she did not want to be sterilized. It was not that she feared the procedure, but rather that her husband had a second wife. She explained that if she got sterilized, she would not be able to have any more of his children, which would put the younger wife at an advantage and with higher status. We were all speechless and out of counseling talking points to address her concern. And yet, in an area where 23% of married women have a husband that has at least one other wife, hers was a very real concern. If her status in her home and community center around the number of children she has, then it’s clear how an operation that made her unable to have any more children would be devastating. And yet this woman had no real choice. And worst we had no options to offer. She could either get sterilized and stop being a “valued” woman or not have the procedure and be homeless and away from her children. In the end the medical staff convinced her into getting the sterilization out of concern for her health. But I couldn’t help but feel like she had been coerced by her husband and community and failed by us.

It is my hope that by the time that her baby girl is in need of FP services the social norms in this community will have changed to the point that she never has to face a similar choice in her future. Because it is clearly more than just about making FP services available, women need to be empowered.

The Western Region of Kenya has one of the highest fertility rates (TFR=5.6) in the country and over 27% of sexually active women there have an unmet need for contraceptives. The Packard Foundation is currently funding a project in this region that is being led by the African Population and Health Research Center, in collaboration with the Division of Reproductive Health, Ministry of Public Health. The other major partners funded under this grant are Family Health Options Kenya, Marie Stopes Kenya (which organized the mobile clinic I visited), and the Great Lakes University of Kisumu.

The long term goals of the project are to reduce unwanted and mistimed pregnancies, unsafe abortion, maternal morbidity and mortality, and the fertility rate, as well as to improve the general health status of the target communities by encouraging uptake of long term contraceptive methods, influencing men’s attitudes towards family planning, and influencing desired family size and fertility intentions among women and men.

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The Bixby Center for Population, Health, and Sustainability is dedicated to helping achieve slower population growth within a human right framework by addressing the unmet need for family planning. Learn more